IMPORTANCE: Patients with severe micrognathia are predisposed to airway obstruction. Mandibular distraction osteogenesis (MDO) is an alternative to tracheotomy that lengthens the mandible in order to improve the retrolingual airway. This study presents outcomes from one of the largest cohorts reported. OBJECTIVE: To assess the rate and predictors of surgical success and complications among (1) patients who underwent MDO prior to other airway procedures (MDO first), and (2) patients who required an initial tracheotomy and were subsequently treated with MDO (tracheotomy first). DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study at a tertiary care pediatric medical center of patients diagnosed as having micrognathia resulting in symptomatic airway obstruction (Pierre Robin sequence) and who underwent MDO from September 1995 to December 2009. INTERVENTIONS: Electronic medical records were reviewed. Multivariable regression analysis was used to assess for predictors of outcome. MAIN OUTCOMES AND MEASURES: Rates of surgical success (defined as either tracheotomy avoidance or decannulation) and complications. Potential predictors included demographics, syndrome presence, follow-up time, and surgical history. RESULTS: A total of 123 patients (61 in MDO-first subgroup, 62 in tracheotomy-first subgroup) underwent MDO during the study period. Median age at time of distraction was 21 months (range, 7 days-24 years). Surgical success and complication rates were 83.6%and 14.8%in the MDO-first subgroup and 67.7%and 38.7%in the tracheotomy-first subgroup. Tracheotomy-first patients were more likely to have a syndromic diagnosis (66.0%vs 43.0%; P = .009) and were older at the time of MDO (median age, 30 months vs 5.1 months; P < .001). Poorer odds of success were associated with the need for 2 or more other airway procedures (odds ratio [OR], 0.14 [95%CI, 0.02-0.82]) in the MDO-first subgroup and craniofacial microsomia or Goldenhar syndrome (OR, 0.07 [95%CI, 0.009-0.52]) in the tracheotomy-first subgroup. CONCLUSIONS AND RELEVANCE: Mandibular distraction osteogenesis has a high rate of success in avoiding tracheotomy. Patients who required a tracheotomy before MDO had a lower success rate in achieving decannulation and a higher rate of complications. However, these patients also had a higher rate of syndromic diagnoses and associated comorbidities. Patients with Goldenhar syndrome have a decreased likelihood of surgical success.
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机译：重要提示：严重小白癜风患者易患气道阻塞。下颌牵引成骨术（MDO）是气管切开术的替代方法，可延长下颌骨以改善舌后气道。这项研究显示了报告的最大队列之一的结果。目的：评估（1）在其他气道手术之前先行MDO的患者（首先是MDO）和（2）需要初次气管切开并随后接受MDO治疗（首先是气管切开术）的患者的手术成功率和并发症的发生率以及预测因素）。设计，地点和参与者：于1995年9月至2009年12月接受MDO的三级儿科医疗中心的回顾性队列研究，该患者被诊断为患有微念头症并导致症状性气道阻塞（Pierre Robin序列）的患者。已审查。多变量回归分析用于评估结果的预测因子。主要结果和措施：手术成功率（定义为避免气管切开术或无气管切开术）和并发症的发生率。潜在的预测因素包括人口统计学，综合征的存在，随访时间和手术史。结果：在研究期间，共有123例患者（MDO-第一亚组61例，气管切开术-第一亚组62例）接受了MDO。分心时的中位年龄为21个月（范围7天至24岁）。 MDO第一组的手术成功率和并发症发生率分别为83.6％和14.8％，气管切开术第一组的手术成功率和并发症发生率分别为67.7％和38.7％。先行气管切开术的患者更有可能被诊断为综合征（66.0％vs 43.0％; P = .009），并且在MDO时年龄更大（中位年龄为30个月vs 5.1个月; P <.001）。在MDO第一亚组和颅面部微索氏症或Goldenhar综合征（OR为0.07）中，成功几率较差与需要2种或更多种其他气道手术（赔率[OR]，0.14 [95％CI，0.02-0.82]）相关。 [95％CI，0.009-0.52]）。结论和相关性：下颌骨牵引成骨在避免气管切开术方面具有很高的成功率。在进行MDO之前需要进行气管切开术的患者，实现脱环的成功率较低，并发症的发生率较高。但是，这些患者的症状诊断率和合并症也较高。患有Goldenhar综合征的患者手术成功的可能性降低。
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